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Pharm Spring 2014 > Anesthetics > Flashcards

Flashcards in Anesthetics Deck (54)
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1

What is monitored anesthesia care?

Using sedatives and other agents, but the dose is low enough that the patient remains responsive and able to breath without assistance. We use this for simple procedures and minor surgery. MAC generally refers to IV sedation.

2

What is the main difference between MAC and GA?

Patients in GA no longer respond to stimuli

3

Define minimal, moderate, and deep sedation, and general anesthesia

Minimal Sedation (Anxiolysis)- Pt responds normally to verbal commands. Cognitive function and coordination may be impaired. Vent and CV function unaffected.

Moderate Sedation (Conscious sedation)- responds purposefully to verbal commands alone or with light tactile stimulation. Airway and ventilation are fine. CV usually fine.

Deep- Not easily aroused. Responds purposefully to repeated/painful stimuli. Ventilation and airway may be impaired. CV usually fine.

GA- Not arousable even by painful stimuli. Needs assistance with patent airway, may need PPV. CV may be impaired.

4

Effects of general anesthesia

No sensory perception
Loss of consciousness
No recall of events
Immobility

Others include muscle relaxation (although you don't NEED muscle relaxants), suppression of the ANS, analgesia, and anxiolysis.

5

What is the only anesthetic that has analgesic properties?

Ketamine. Our other anesthetics just cause loss of consciousness.

6

General induction sequence

Pre-op meds (anxiolytic, antibiotic, etc)
Induction agent
Paralytic
Maintenance agent
Opoids
Antiemetics
Reversal agents (reversal of the paralytic)

7

Why do we need to give antiemetics?

Because the opioids and anesthetics can cause nausea

8

5 effects of benzodiazepines

ASAAM
1) Anxiolysis
2) Sedation
3) Antegrade amnesia
4) Anticonvulsant
5) Muscle relaxation (at the spinal level)

9

Prototype for benzos

Diazepam (Valium)

10

Midazolam (Versed) is an example of this class of drugs)

Benzos

11

How do benzodiazepines work?

Potentiating the binding of GABA to GABAa receptors and increases the potency of GABA x 3.
Causes Cl- influx, hyperpolarizing the cell and decreasing its excitability

12

When would benzos drop your BP?

When used in large doses for induction (due to a decrease in SVR), especially with hypovolemia. Also may decrease because the pt was anxious before and is now more relaxed.

13

When are benzos contraindicated?

Pregnancy

14

What do opioids bind to?

On Mu receptors which can be located on either the pre or post-synaptic membranes

15

At what anatomical locations do opioids work?

In the brainstem, spinal cord, and peripheral tissues

16

Opioids result in decreased release of this NT

Substance P

17

Why should we try to avoid a benzo/opioid cocktail pre-operatively?

They have a synergistic effect on ventilation

18

What is the benefit of using opioids for general anesthesia?

It doesn't drop BP (although it will cause bradycardia!)

19

How much fentanyl would be needed to induce GA?

50-100mcg/kg

20

This class of drugs are the classic induction agents

Barbiturates. Because the end result is depressing the reticular activating system (causing sleep).

21

Which are more effective as anticonvulsants, benzos or barbiturates?

Barbiturates

22

Which class of medications, when injected arterially, will cause gangrene and nerve damage?

Barbiturates

23

What can cause enzyme induction?

Smoking, ETOH, and barbiturates.

24

What barbiturate is the most potent enzyme inducer?

Phenobarbital

25

What's the deal with barbiturate allergies?

It's very rare (1:30,000), but highly fatal

26

Barbiturates increase the metabolism of these drugs

Oral anticoagulants, phenytoin, TCAs, corticosteroids, and Vitamin K

27

Barbiturates should be avoided in patients with

Porphyria.

Barbs cause rapid heme production through the stimulation of the enzyme D-aminolevulinic acid synthetase. People with porphyria have shitty heme. So if you give benzos to these people, they will have a shit ton of shitty heme.

28

Do barbiturates cross the placenta?

Yes.

29

Barbiturates stimulate this enzyme responsible for heme production

D-aminolevulinic acid synthetase

30

What is included in the base of propofol?

Egg, soy, and glycerol

31

Bronchoconstriction is often related to what?

Patient not being deep enough. Asthmatics are at an even higher risk of this if they are not deep enough. You want asthmatics to be very deep because they are at high risk of bronchoconstriction when stimulated.

32

Can propofol be given to those with egg allergies?

Yes

33

This medication attaches to the B1 subunit of the GABAa receptor

Propofol

34

Succinylcholine binds to what type of receptors?

Nicotinic ACh receptors

35

Succinylcholine is often replaced with

Rocuronium

36

How can we reduce myalgias with succ?

Give a small dose of a non-depolarizing agent first, and then give the succ

37

If giving succ to kids, what should you also give them and why?

Give atropine. Succ blocks ACh receptors, which can cause profound bradycardia in kids.

38

This medication is a POTENT trigger of malignant hyperthermia

Succinylcholine. Isoflurane can also trigger MH.

39

Succ should be avoided in

Patients with atypical acetylcholinesterase. Remember this is familial, so if the patient describes a family member not waking up after surgery, etc., then don't draw this up as an emergency medication.

40

Patients with these diseases are at higher risk for hyperkalemia when given succ

Burns, trauma, nerve damage, neuromuscular diseases, and renal failure. `

41

Prototype for the non-depolarizing muscle relaxants

Vecuronium

42

Structure of vecuronium

Monoquarternary aminosteroid

43

What receptors does vecuronium work on?

Pre and post-synaptic nACh receptors

44

For what patients will vecuronium not work?

Burn patients

45

Things to look out for with vecuronium

Residual NM blockage and increased likelihood of recall

46

How are inhalational anesthetics eliminated?

Via the lungs. We can alter elimination by varying the RR. Liver and kidney disease won't affect metabolism or elimination.

47

What is usually the only inhalational anesthetic used for induction?

Sevoflurane

48

Do inhalational anesthetics act as a bronchodilator or constrictor?

Bronchodilator

49

What is the MAC of an anesthetic?

The alveolar concentration of an inhalational agent at which 50% of patient will not move to a noxious stimulus

50

What is the only inhalational agent we used that will not provide anesthesia by itself?

Nitrous oxide (N2O)

51

Local anesthetics will block APs ONLY if the Na channels are in this state

Inactivated-closed

52

If your patient starts having signs of local anesthetic toxicity, you should give them this

Versed (because the patient will probably have a seizure)

53

Local anesthetic with high risk for cardiac toxicity

Bupivicaine (can cause arrythmias, AV blocks, hypotension, and arrest)

54

What class of drug would you want to give to induce anesthesia in a patient with high ICP?

Barbiturates